title: Bridging defects in chronic spinal cord injury using peripheral nerve grafts combined with a chitosan-laminin scaffold and enhancing regeneration through them by co-transplantation with bone-marrow-derived mesenchymal stem cells: case series of 14 patients.
abstract: OBJECTIVE
  To investigate the effect of bridging defects in chronic spinal cord injury using peripheral nerve grafts combined with a chitosan-laminin scaffold and enhancing regeneration through them by co-transplantation with bone-marrow-derived mesenchymal stem cells.
  
  
  METHODS
  In 14 patients with chronic paraplegia caused by spinal cord injury, cord defects were grafted and stem cells injected into the whole construct and contained using a chitosan-laminin paste. Patients were evaluated using the International Standards for Classification of Spinal Cord Injuries.
  
  
  RESULTS
  Chitosan disintegration leading to post-operative seroma formation was a complication. Motor level improved four levels in 2 cases and two levels in 12 cases. Sensory-level improved six levels in two cases, five levels in five cases, four levels in three cases, and three levels in four cases. A four-level neurological improvement was recorded in 2 cases and a two-level neurological improvement occurred in 12 cases. The American Spinal Impairment Association (ASIA) impairment scale improved from A to C in 12 cases and from A to B in 2 cases. Although motor power improvement was recorded in the abdominal muscles (2 grades), hip flexors (3 grades), hip adductors (3 grades), knee extensors (2-3 grades), ankle dorsiflexors (1-2 grades), long toe extensors (1-2 grades), and plantar flexors (0-2 grades), this improvement was too low to enable them to stand erect and hold their knees extended while walking unaided.
  
  
  CONCLUSIONS
  Mesenchymal stem cell-derived neural stem cell-like cell transplantation enhances recovery in chronic spinal cord injuries with defects bridged by sural nerve grafts combined with a chitosan-laminin scaffold.
authors.forename: Sherif M
authors.initials: SM
authors.lastname: Amr
authors.forename: Ashraf
authors.initials: A
authors.lastname: Gouda
authors.forename: Wael T
authors.initials: WT
authors.lastname: Koptan
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Galal
authors.forename: Dina Sabry
authors.initials: DS
authors.lastname: Abdel-Fattah
authors.forename: Laila A
authors.initials: LA
authors.lastname: Rashed
authors.forename: Hazem M
authors.initials: HM
authors.lastname: Atta
authors.forename: Mohammad T
authors.initials: MT
authors.lastname: Abdel-Aziz
mesh_terms: D000293:Adolescent; D000328:Adult; D001854:Bone Marrow Cells / Q000502:physiology*; D017690:Cell Transplantation / Q000379:methods*; D002648:Child; D048271:Chitosan / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007797:Laminin / Q000627:therapeutic use*; D008297:Male; D059630:Mesenchymal Stem Cells / Q000502:physiology*; D008875:Middle Aged; D009416:Nerve Regeneration / Q000187:drug effects / Q000502:physiology; D010525:Peripheral Nerves / Q000502:physiology*; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000601:surgery*; D055815:Young Adult
chemical_list: D007797:Laminin; D048271:Chitosan
keywords: Nerve grafting; Neurorecovery; Paraplegia; Spinal cord injuries; Stem cell transplantation